Sistema de Prompt para Assessor de Preparação de Reclamações de Seguro

{ "claim_summary": { "claim_type": "home", "summary": "A washing machine hose burst on 3 November, causing water damage to your kitchen floor, lower cabinets, and the downstairs neighbor's ceiling. You have reported the claim and have some initial evidence, but need to build a complete submission packet.", "date_of_loss": "2026-11-03", "region": "Netherlands", "currency": "EUR", "estimated_loss": 6500, "assumptions": [ "Your policy is a contents and buildings policy with a 250 EUR excess.", "The policy likely covers sudden water damage, but this needs confirmation.", "The neighbor's damage may be covered under liability, but this is uncertain.", "You own the flat, so your landlord is not involved.", "The plumber's invoice and photos are from the same evening of the loss." ] }, "coverage_to_confirm": [ { "section": "Buildings", "likelihood": "likely", "why": "The floor and cabinets are likely considered part of the building structure.", "confirm_in_policy": "Check if sudden water damage is covered and if there are any exclusions for wear and tear." }, { "section": "Contents", "likelihood": "possible", "why": "If any personal belongings were damaged, they would be covered under contents.", "confirm_in_policy": "Verify if contents coverage applies to items in the kitchen." }, { "section": "Liability", "likelihood": "possible", "why": "The neighbor's ceiling damage may be covered under liability if you are found responsible.", "confirm_in_policy": "Check if liability coverage includes damage to third-party property." }, { "section": "Alternative accommodation", "likelihood": "unlikely", "why": "You did not mention being displaced from your home.", "confirm_in_policy": "Confirm if this is applicable only if the home is uninhabitable." } ], "required_documents": [ { "document": "Policy documents and schedule", "purpose": "To confirm coverage, excess, and conditions.", "status": "have", "how_to_get_it": null, "priority": "high" }, { "document": "Claim reference and correspondence", "purpose": "To track communication and deadlines.", "status": "have", "how_to_get_it": null, "priority": "high" }, { "document": "Photos and videos of damage", "purpose": "To document the extent of the loss.", "status": "have", "how_to_get_it": null, "priority": "high" }, { "document": "Plumber's invoice for emergency repair", "purpose": "To prove the cause and cost of immediate repairs.", "status": "have", "how_to_get_it": null, "priority": "high" }, { "document": "Broken hose (kept in a bag)", "purpose": "To show the cause of the damage.", "status": "have", "how_to_get_it": null, "priority": "high" }, { "document": "Proof of ownership or purchase for damaged items", "purpose": "To substantiate the value of damaged contents.", "status": "missing", "how_to_get_it": "Gather receipts, bank statements, or warranty cards for damaged items.", "priority": "medium" }, { "document": "Repair estimates for floor and cabinets", "purpose": "To quantify the cost of repairs.", "status": "missing", "how_to_get_it": "Obtain at least two quotes from licensed contractors.", "priority": "high" }, { "document": "Neighbor's damage estimate", "purpose": "To include in liability claim if applicable.", "status": "missing", "how_to_get_it": "Ask the neighbor or their landlord for an estimate or invoice.", "priority": "medium" }, { "document": "Proof of income (if claiming loss of use)", "purpose": "To support any additional living expenses.", "status": "not_applicable", "how_to_get_it": null, "priority": "low" } ], "nice_to_have_documents": [ { "document": "Maintenance records for the washing machine", "why_it_helps": "Shows the hose was not neglected, reducing wear and tear risk." }, { "document": "Photos of the kitchen before the loss", "why_it_helps": "Provides a baseline for the condition of the floor and cabinets." }, { "document": "Witness statements from neighbors or family", "why_it_helps": "Corroborates the timeline and extent of the damage." }, { "document": "Bank statements showing purchase of damaged items", "why_it_helps": "Supports the value of contents claims." } ], "photo_and_evidence_checklist": [ { "item": "Overall view of the kitchen", "must_show": "The full extent of water on the floor and lower cabinets.", "tip": "Take wide-angle shots from multiple angles." }, { "item": "Close-up of the burst hose", "must_show": "The rupture point and any corrosion or wear.", "tip": "Keep the hose in a sealed bag and photograph it with a ruler for scale." }, { "item": "Damaged cabinets", "must_show": "Swelling, discoloration, or warping.", "tip": "Open doors and drawers to show interior damage." }, { "item": "Floor damage", "must_show": "Warping, staining, or lifting of tiles or planks.", "tip": "Use a level to show unevenness if possible." }, { "item": "Neighbor's ceiling", "must_show": "Water stains, peeling paint, or sagging.", "tip": "Ask the neighbor for permission to photograph and document the date." }, { "item": "Serial numbers and model of washing machine", "must_show": "The brand, model, and serial number for reference.", "tip": "Photograph the label on the machine." }, { "item": "Measurements of affected areas", "must_show": "Dimensions of the damaged floor and cabinet sections.", "tip": "Use a tape measure and note the measurements in a notebook." }, { "item": "Date and time stamps", "must_show": "The date and time of each photo.", "tip": "Enable timestamp on your camera or use a date app." } ], "deadlines": [ { "deadline": "Notification to insurer", "date_or_timing": "Already done on 4 November", "source": "given_by_user", "consequence_if_missed": "None, already completed." }, { "deadline": "Submit proof of loss", "date_or_timing": "Typically within 30 days of loss", "source": "typical_verify_in_policy", "consequence_if_missed": "Claim may be delayed or denied." }, { "deadline": "Obtain repair estimates", "date_or_timing": "Within 2 weeks of loss", "source": "recommended_target", "consequence_if_missed": "May delay claim processing." }, { "deadline": "Submit all documents", "date_or_timing": "Within 30 days of loss", "source": "recommended_target", "consequence_if_missed": "May delay claim processing." }, { "deadline": "Appeal deadline", "date_or_timing": "Check policy for specific timeline", "source": "typical_verify_in_policy", "consequence_if_missed": "Lose right to appeal." } ], "questions_for_insurer": [ { "question": "Does my policy cover sudden water damage from a burst hose?", "why_ask": "To confirm coverage for the primary cause of loss.", "get_answer_in_writing": true }, { "question": "Is the neighbor's ceiling damage covered under my liability section?", "why_ask": "To know if the neighbor's claim is included.", "get_answer_in_writing": true }, { "question": "What is the deadline for submitting the proof of loss and all supporting documents?", "why_ask": "To ensure you meet all deadlines.", "get_answer_in_writing": true }, { "question": "Do I need to obtain multiple repair estimates or can I use one?", "why_ask": "To know the insurer's requirement for estimates.", "get_answer_in_writing": true }, { "question": "Will the adjuster visit the property, and if so, when?", "why_ask": "To prepare for the visit and ensure all evidence is available.", "get_answer_in_writing": true } ], "red_flags": [ { "issue": "Discarded swollen skirting boards", "risk": "high", "fix": "If possible, retrieve them or take photos from your phone to show the damage." }, { "issue": "Old hose may be considered wear and tear", "risk": "medium", "fix": "Provide maintenance records or receipts for the hose to show it was in good condition." }, { "issue": "Late notice (reported next day)", "risk": "low", "fix": "Explain the delay was due to being away and provide evidence of the timeline." }, { "issue": "Inconsistent amounts (neighbor estimate unknown)", "risk": "medium", "fix": "Obtain a written estimate from the neighbor's landlord as soon as possible." } ], "submission_packet": [ { "order": 1, "file_name": "01_Cover_Note.pdf", "contents": "Brief summary of the claim and list of documents." }, { "order": 2, "file_name": "02_Policy_Documents.pdf", "contents": "Policy schedule and relevant terms." }, { "order": 3, "file_name": "03_Claim_Reference.pdf", "contents": "Copy of the claim reference and any correspondence." }, { "order": 4, "file_name": "04_Photos_and_Videos.zip", "contents": "All photos and videos organized by date and area." }, { "order": 5, "file_name": "05_Plumber_Invoice.pdf", "contents": "Invoice for emergency repair." }, { "order": 6, "file_name": "06_Broken_Hose_Evidence.pdf", "contents": "Photos of the hose and a note on its condition." }, { "order": 7, "file_name": "07_Repair_Estimates.pdf", "contents": "Estimates for floor and cabinet repairs." }, { "order": 8, "file_name": "08_Neighbor_Damage_Estimate.pdf", "contents": "Estimate or invoice for the neighbor's ceiling repair." }, { "order": 9, "file_name": "09_Proof_of_Ownership.pdf", "contents": "Receipts or bank statements for damaged contents." }, { "order": 10, "file_name": "10_Additional_Evidence.pdf", "contents": "Any maintenance records, witness statements, or prior photos." } ], "cover_note": "This packet contains all documents and evidence related to the water damage claim on 3 November. Please review and contact me if any additional information is needed.", "next_actions": [ { "action": "Contact the insurer to confirm coverage and deadlines.", "owner": "You", "target_date": "2026-11-10" }, { "action": "Obtain repair estimates from at least two contractors.", "owner": "You", "target_date": "2026-11-15" }, { "action": "Ask the neighbor for a written estimate for the ceiling damage.", "owner": "You", "target_date": "2026-11-12" }, { "action": "Gather proof of ownership for damaged items.", "owner": "You", "target_date": "2026-11-14" }, { "action": "Assemble the submission packet and send to the insurer.", "owner": "You", "target_date": "2026-11-20" } ], "disclaimer": "This is not legal or financial advice, and the policy wording decides coverage." }